ActiveY Parishram

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ActiveY Parishram

Executive Summary

Affordable and quality health care facilities are still dream for majority in rural India; problem

has been further escalated by ignorance and unawareness regarding healthy living. In this

demanding situation, collaboration of all the stakeholders including panchayat, NGOs and

Government is imperative to overhaul the rural health care scenario. NGOs and Government

should now direct more energy towards curative care rather than preventive care. Also transfer of

responsibility and accountability from government institutions to NGOs and panchayat will help

in increasing awareness, eradicating ignorance and bringing in quality health care facilities to the

masses.

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Introduction

In recent times Indian economy has been growing at tremendous rate and has gained rank in

order of top 10 economies of world. But on the side of human development and health index we

are still positioned in lower half of the ranking. This striking contrast gives us a cue that the

problem is deep rooted not just in policies but also in our socio-economic fabric. In order to find

the cause of this multi-facet problem, identification and analysis is done at social, economic,

financial and political platform.

Problem Identification

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Social Factors

Traditionally we have been oriented towards seeking a cure for an existent medical condition.

But to tackle the increasing health challenges which we face because of unhealthy eating habits

and living condition, we need to focus on preventive care. Curative care differs from preventive

care as it aims at prevention of the diseases through the adoption of proper life styles,

immunization, etc.

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FOCUS ON CURATIVE CAREIGNORANCE ON PART OF PARENTSLACK OF AWARENESSUNHEALTHY EATING HABITSWORKLOAD ON CHILDRENLACK OF SCHOOL INVOLVEMENT IN CHILDREN HEALTH

CONCENTRATION OF RESOURCES IN URBAN AREASINADEQUATE GOVERNMENT HEALTH FACIILITESUNAVAILABILITY OF TRAINED HEALTH WORKERS LACK OF QUALITY HEALTH SERVICESn

NO TIME BOUND GOALNO INVOLVEMENT OF PANCHAYAT OR COMMUNITY COMPETING PRIORITIES

FEW PUBLIC-PRIVATE -NGOs COLLABORATIONNO COMMUNITY BASED HEALTH INSURANCE UNAFFORDABLE HEALTH SERVICES

SOCIAL ECONOMIC

POLITICSFINANCE

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Fig2. Nutritional status of children in India

Majority of the population at the bottom of pyramid is uneducated and unconnected with the

main stream of development initiatives. This has led to:

1. Inability to understand the importance of health in initial years of child mental/physical

development. This lead to overloading child with home tasks.

2. Lack the awareness required to address the child health problem on the basis of early

symptoms.

3. Inability of schools to keep track of child health.

Economic Factors

India faces a huge need gap in terms of availability of number of hospital beds per 1000

population. With a world average of 3.96 hospital beds per 1000 population India stands just a

little over 0.7 hospital beds per 1000 population. Moreover urban-rural divide is very explicit.

There are only 0.2 hospitals beds as compared to 3 in urban areas. Moreover the public

expenditure per 1000 population in rural areas is only Rs. 80,000 as compared to Rs. 560,000 in

urban areas. Unavailability and competency of trained health workers is also a point of concern.

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NUTRITIONAL STATUS OF INDIAN CHILDREN, 2005-06 (IN PER CENT)SOURCE:NATIONAL FAMILY HEALTH SURVEY-3 (2005-06)

CHILDREN UNDER THREE WHO ARE

STUNTEDWASTED

UNDERWEIGHT

URBAN37

19

30

RURAL47

24

44

ALL-INDIA45

23

40

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Political Factors

Large number of well intentioned polices are designed by government but only few of them able

to show the intended results. It is mainly because goals are generally not time bound hence it

brings in corruptions and inefficiency. Moreover panchayat is generally not involved in rollout

hence they fail to bring in the required participation in the health program.

Moreover, there are several parallel health programs going on with each having its own focus

area therefore it sometimes lead to conflict of interest between different agencies which leads to

duplication of efforts and thereby wastage of scarce resources.

Financial Factors

Inadequacy of affordable health care has lead people in rural areas to either opt for inadequate

government health facilities or expensive facilities of private institutions. Though some NGOs

provide medical services through hospitals and mobile vans but these are too few in number to

bring in the necessary affordability and accessibility to health services. Also absence of

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AREAS

HOSPITAL BEDS

DOCTORS

PUBLIC EXPENDITURE

OUT OF POCKET

RURAL(PER 1000 POPULATION)

0.2

0.6

Rs. 80,000

Rs. 750,000

URBAN (PER 1000 POPULATION)

3.0

3.4

Rs. 560,000

Rs. 1,150,000

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community based health insurance has deprived needy people of the ready access to money and

efficient health care services.

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The Immediate Response

Immediate responses are designed to be highly focused and oriented towards masses that are in

dire need of health services.

1. Bringing in medical facility to each and every village would be bit difficult initially

therefore Melas/Haat should be used to launch the concept of a HEALTH CAMP. Since

resources are limited therefore to maximize their utilization we can use same platform for

multiple purpose:

a. Evening/Night time at camp: NGO and government agencies can show especially

designed projected videos showcasing the symptoms of health related issues

covering fields like anemia, TB etc. Also they can highlight the importance of

both preventive and curative methodology.

b. Day time at camp: NGO can invite guest medical practitioners from nearby cities

to provide free consultation along with free distribution of medicine like folic acid

and vitamins to the villagers.

2. NGOs can design special program where they can bring in educated and trained volunteer

from the cities to publicize healthy eating habits in villages. Also volunteer must ensure

with the help of panchayat that they could prevent household chores and manual work for

children below 15 years.

3. NGOs along with district health and education office should actively involve schools in

ensuring the health of children. Regular health camps can be arranged at rural schools to

keep track of various symptoms of disease in children.

4. Village leadership should be convinced to provide subsidized transport to the children

coming from poor background. It will help already malnourished children to maintain

energy level.

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5. NGO can make use of mHealth, a practice of medical and public health, supported by

mobile devices. mHealth applications include the use of mobile devices in collecting

community and clinical health data, delivery of healthcare information to practitioners

and patients.

Motivations behind using mHealth service arise from 2 factors:

a. Large mass of rural inhabitants, high burden of disease prevalence and low health

care workforce.

b. Potential of lowering information and transaction costs in order to deliver improved

healthcare.

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Long term strategy focus area

Fig. 4 Long term plan outcome

Preventive Health Practices

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CURATIVE CARE

LONG TERM STRATEGY TO

COMBAT HEALTH CARE PROBLEMS OF UNDERPRIVILEGED

PEOPLE

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Till now emphasis on preventive care had been on a lower priority because of the burden of

communicable diseases like TB, Vector borne diseases etc. Improvement in health status

necessitates expanding our energies with equal emphasis on preventive care particularly in

the case of HIV/AIDS, child health, and polio. This can be done by awareness campaigns

emphasizing the need of easily available source of various nutrients, vitamins etc. Also

vitamin and folic acid capsule should be freely distributed especially for children and

pregnant ladies.

On economic front cost effective ratio shows the saving for preventive measure rather than

treatment for existing health problems.

Improvement in Rural Health Care Infrastructure and Services

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Rural areas have been neglected historically since the main inputs have been limited to family

planning and more recently immunization services. The only way to remedy this gross disparity

is more resources for the health sector at one level and greater equity in distribution of resources

between rural and urban areas at another level.

Partnership with not-for-profit NGOs has also gradually evolved from that of advocacy to actual

partnership in quality service delivery and monitoring since Seventh Five-Year Plan. The

government has shown willingness to hand over the government infrastructure to NGOs or other

forms of people's groups for providing health care to the masses within the assigned budgetary

provision. This option can be tried in selected blocks as a pilot project.

A desired PPP framework under ambit of NRHM would enable capitalization of governmental

resources while ensuring private sector efficiencies in delivery.

Empowerment of Panchayati Raj Institutions

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In order to make health reform touch each and every nook-corner of rural India it is imperative to

empower the community. The Panchayati Raj Institutions (PRI), right from the village level to

district level, would have to be given an ownership of the public health delivery system in their

respective jurisdiction. Village Health Committee should be given certified vocational training

by NGOs and district level health office for capability development so that in near future they

should be able to develop and deliver health plan for each village.

Outcome of one of such field based study in Gujarat:

a. Improvement in the quality of health care services, especially through ensuring

better attendance of health care functionaries at the local level, as well as exerting

moral pressure on health staff not to shirk from work.

b. Watchful participation of local communities has contributed in some measure in

improving the supplies of drug and equipment by assisting health staff by

bringing the deficiencies in the supplies to the attention of higher authorities.

Community based health insurance by NGOs

In a country of over a billion people, barely 30 million are covered under community health

insurance scheme by NGOs and other community organizations. In order to reduce the distress

of poor household, there is therefore an imperative need to involve NGOs and community based

organizations as insurance providers and as a third party administrators. Innovative and flexible

insurance products need to be developed and marketed. The ultimate aim should be to provide

health security to the poor by be ensuring accessible, affordable, accountable and good quality

hospital care.

Fund Generation through Philanthropy

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Philanthropic activity framework in India can be understood with the help of following

constituents.

1. Donors: Individuals, corporations and governments.

2. Supporting Networks: Philanthropic venture, Red Cross, dedicated funds like the Prime

Minister’s National Relief Fund.

3. Grass Root NGO: These NGO disburses donations as part of their healthcare activities.

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In India individual and corporate donations make up only 10 percent of charitable giving. While

by comparison, nearly three-fourths of all philanthropy in the US is undertaken by individuals.

Hence there lies a huge potential in tapping charity from high- net-worth individual.

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